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Healthcare 2.0: what does the future hold in the Gulf?

What does the future of medicine look like in the region? Will we be living longer, better quality lives? And how can hospitals adapt to new technologies? Dr Rakesh Suri, CEO of Cleveland Clinic Abu Dhabi, is in a good position to answer these questions

Congratulations, firstly, on being part of the surgical team that conducted the first heart transplant in the UAE last year at Cleveland Clinic. It was truly a remarkable day and it also occurred on the eve of the 50th anniversary of the first human heart transplant ever to be performed by Dr Christiaan Barnard in South Africa.

Does this mean that patients will be able to have more complex procedures performed here in the UAE rather than travelling abroad?

That’s indeed true. We were brought to the UAE to deliver complex and critical care closer to patients in their home communities, rather than them having to travel abroad, which carries both an economic and human cost. That never existed here before, and for a First World nation we really only had Second World medicine. There are pockets of excellence but there wasn’t a healthcare system commensurate with the level of sophistication that you see in the rest of society.

The cutting-edge of medicine is to diagnose before symptoms begin

Do you plan on expanding Cleveland Clinic in this region?

We are a global organisation, and with our launch in Abu Dhabi in 2015 we’ve become the world’s first truly globally integrated healthcare network. If a patient walks in the door in Florida, Ohio, Abu Dhabi, Toronto or in London they have access to 57,000 of the most sophisticated and connected medical minds on the planet. We’re able to transmit medical records. We can exchange images and data or have video calls with our colleagues around the globe. And we’re ready and able to welcome a patient of ours to any healthcare portal within the network.

Are there some examples of how this has worked in practise in Abu Dhabi?

Yes. This year we performed a series of organ transplants that were firsts for the nation, with the UAE’s first fully functional multi-organ transplant programme. And this was made possible by the far-sighted regulators and legislators of this country who signed the brain-dead donor law in 2017. This is impacting the healthcare landscape in a way that’s never before been seen.

What new technologies will facilitate the hospitals of tomorrow?

Blockchain, artificial intelligence (AI), cloud-based computing and data sharing are all great innovations that are being leveraged across many industries, and we’re aligned with all that. What does that mean practically speaking? Healthcare is traditionally siloed into departments, whereas at Cleveland Clinic we’re organised around the patient. For example, a patient with a heart problem doesn’t care whether they see a surgeon, technician, cardiologist, doctor or alternative care provider. All that matters is that they walk away feeling well and able to get on with their life. That is the most innovative concept in medicine and is the principle upon which Cleveland Clinic Abu Dhabi was founded.

That sounds like an obvious thing to do but in practice could be quite chaotic if badly managed…

Exactly. We see ourselves as a team of teams. We don’t incentivise our providers or any of our caregivers based on productivity by numbers. We incentivise our teams to achieve the best outcome at the lowest cost. And that’s also a novel concept because it aligns the organisation to the true goal which is the best outcome for the patient, not only in hospital but when they go home. When people think about traditional healthcare they think about big hospitals, but that’s not where the industry is going. Healthcare is about going into the community and embedding the principles of staying well. The cutting-edge of medicine is to diagnose a problem before symptoms begin, and then get the patient into the system for the right therapy, at the right time, and then get them out of hospital as quickly as possible and follow them for the months and years to come. This helps us understand how our treatments are impacting the patients and the communities we serve. It is end-to-end healthcare through the generations.

Healthcare is about staying well. The cutting-edge of medicine is to diagnose a problem before symptons begin

We have huge issues in this part of the world with diseases such as diabetes, which are associated with poor diets and lifestyle. How is Cleveland Clinic tackling these issues in the community?

Prescribed preventative maintenance is the key. While a third to a quarter of the population may have a predisposition to diabetes, certain accelerants play a huge role. Are there toxins in the air, your environment or in your food? Do you eat a healthy, plant-based diet and take regular exercise? Are you working to reduce stress? We teach all these as a patient comes in our door. And we quickly realised that the UAE has a robust network to diagnose people early and only refer them to centres like ours when they require complicated specialty care. So we’re working with Mubadala, our stakeholder, to develop a primary care population healthcare management network that will refer patients via telephone, video and a network of primary care providers to the right care at the right time in the right location. This will utilise blockchain, artificial intelligence, video appointments and electronic medical records. This improves the health of the nation and decreases healthcare costs for the country.

All this comes at a cost of course. Cleveland Clinic is presumably expensive and only available to a certain segment of the population?

That is an incorrect assumption. We know through decades of research that incorrect care from doctors, nurses and technicians who are not incentivised in the right way leads to unnecessary healthcare costs and poor outcomes. As I mentioned before, when a patient enters our system they are always referred to the right provider, which reduces unnecessary diagnostics and tests. The number of drugs that we prescribe has been proven to be less than other providers. And if a patient requires a sophisticated procedure, we deliver it in their home communities. This prevents them from having to travel abroad, which is much more costly to the nation and the family themselves.

What do you think of the insurance system here in the UAE?

No other nation has provided the type of regulatory framework and mandatory insurance-based support to ensure that patients with serious conditions are referred to centres of excellence where they receive the best care. We’ve been provided unique access and coverage to treat patients, which is really remarkable. So when you ask whether patients are able to leverage insurance the answer is yes they can, and people need to know that the rulers and the regulators have taken bold moves to ensure this happens.

This is all great, but we have to go back to the fact that this nation has a big issue in terms of chronic diseases…

This is largely based on the patients that have been sent abroad. When we delay care until they are suffering from end-stage organ disease then it is indeed true that there is no option other than expensive, complicated and prolonged care. But I go back to what I said earlier: if we teach the principles of wellness early on then we can prevent diseases like diabetes.

Incorrect care from doctors who are not incentivised in the right way leads to unnecessary healthcare costs and poor outcomes

But it’s not being prevented, judging by the statistics…

The rates vary. There are areas with very low rates of chronic debilitating illness and there are areas that are higher in frequency. These are early days and what we need now are partnerships across the different emirates and also the GCC to create a network where we complement rather than compete. But going back to your question, the answer is that this is a young nation where most of the people – both expats and nationals – have the ability to live healthy, long, disease-free lives.

How are you working with the different emirates to do this?

We’ve just opened a clinic in Al Ain. We’re working through Mubadala Healthcare to ensure patients go onto the right care in the right way. We’re also working with our partners in Dubai to see how we can complement the healthcare landscape there. And we’re in discussions with Kuwait, Bahrain and Saudi to have fruitful partnerships emerge in the future.

We need partnerships across the Emirates and also the GCC to create a network where we complement rather than compete

Speaking of the years to come, what will healthcare look like in future?

One thing that’s for certain is that healthcare is the most sustainable, robust business on the planet. Every single person will need it at some stage. But what’s important is that we homogenise it across the globe. And I believe that governments are moving in this direction. This will allow care to be delivered in the community, more frequently and more uniformly. Patients will go to regional centres of excellence when necessary, where highly skilled teams will deliver precise therapy at the lowest cost and with the best outcomes.

In terms of new technologies, every lightbulb at Cleveland Clinic Abu Dhabi has an IP address; every monitor is tracked and we have the ability to study how patients respond to therapy. As a heart surgeon, I can study patients remotely in real time, and also retrospectively looking for trends. This is how we’re able to detect trouble before it starts. As result, I think that people will be healthier for longer and they’ll get sicker later. This will improve lives and decrease costs. If we continue to put the patients at the centre, and work together to create a network then we can provide end-to-end care from the cradle to the end of life.

The expert

Dr Rakesh Suri is CEO and chief of thoracic and cardiovascular surgery at Cleveland Clinic Abu Dhabi. He oversees the hospital’s overall strategy and effective operation as the first-ever US multispecialty hospital to be replicated outside of North America. He has also led the cardiovascular and thoracic surgical team and was involved in the creation of robotic and transcatheter cardiac programmes at Cleveland Clinic Abu Dhabi. He has completed more than 6,000 surgical procedures and helped to make Cleveland Clinic Abu Dhabi home to the most sophisticated group of robotic cardiac surgeons in the world.

Rising price of UAE drugs

Abu Dhabi’s Department of Health recently began the primary stage of an initiative designed to bring down the cost of medicine. According to the state-run WAM news agency, the DoH will encourage healthcare facilities to offer cheaper generic medicine options for patients. Under the mechanism, the DoH will set a reference price for drug categories with an equivalent generic substitute. Patients who wish to claim medications with a higher value than those listed on the reference price list will be required to pay the difference in price.

The UAE is investing heavily to achieve a world-class healthcare system

Diabetes falls in the UAE

Last week, a Ministry of Health survey found that diabetes rates fell to 11.8 percent in 2017, down from 19.3 percent in 2013, when the World Health Organisation (WHO) ranked the UAE 13th globally in terms of diabetes prevalence. Statistics from the International Diabetes Federation (IDF), however, estimate that that 17.3 percent of the UAE population between the ages of 20 and 79 have type 2 diabetes, placing the UAE in 15th place. Economic growth, sedentary lifestyles and poor diets are thought to be the main causes.

Lifestyle diseases including diabetes are among the leading cause of death in the GCC

“State of the Clinic” report

In its “State of the Clinic” annual report, Cleveland Clinic Abu Dhabi noted that in the first six months of 2018, it served more than 278,000 patients, putting it on course to exceed the 475,000 reported for 2017. Additionally, it noted 61,000 same day appointments in H1, compared to over 100,000 for the entirety of 2017. Other milestones included the first heart transplant in the UAE’s history in 2017, and the first liver and lung transplants from deceased owners in 2018.